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Context Robotic partial nephrectomy (RPN) is rapidly increasing; however, the benefit of RPN over laparoscopic partial nephrectomy (LPN) is controversial. Objective To compare perioperative outcomes of RPN and LPN. Evidence acquisition We searched Ovid-Medline, Ovid-Embase, the Cochrane Library, KoreaMed, KMbase, KISS, RISS, and KisTi from their inception through August 2013. Two independent reviewers extracted data using a standardized form. Quality of the selected studies was assessed using the methodological index for nonrandomized studies. Evidence synthesis A total of 23 studies and 2240 patients were included. All studies were cohort studies with no randomization, and the methodological quality varied. There was no significant difference between the two groups regarding complications of Clavien-Dindo classification grades 1–2 ( p =0.62), Clavien-Dindo classification grades 3–5 ( p =0.78), change of serum creatinine ( p =0.65), operative time ( p =0.35), estimated blood loss ( p =0.76), and positive margins ( p =0.75). The RPN group had a significantly lower rate of conversion to open surgery ( p =0.02) and conversion to radical surgery ( p =0.0006), shorter warm ischemia time (WIT; p =0.005), smaller change of estimated glomerular filtration rate (eGFR; p =0.03), and shorter length of stay (LOS; p =0.004). Conclusions This meta-analysis shows that RPN is associated with more favorable results than LPN in conversion rate to open or radical surgery, WIT, change of eGFR, and shorter LOS. To establish the safety and effectiveness outcomes of robotic surgery, well-designed randomized clinical studies with long-term follow-up are needed. Patient summary Robotic partial nephrectomy (PN) is more favorable than laparoscopic PN in terms of lower conversion rate to radical nephrectomy, a favorable renal function indexed estimated glomerular filtration rate, shorter length of hospital stay, and shorter warm ischemia time.

This study examined the anti-inflammatory properties of Ikarisoside A, isolated from Epimedium koreanum (Berberidaceae), in lipopolysaccharide (LPS)-stimulated macrophages. Ikarisoside A inhibited the expression of LPS-stimulated inducible nitric oxide synthase (iNOS) and the production of nitric oxide (NO) in LPS-stimulated RAW 264.7 cells and mouse bone marrow-derived macrophages (BMMs) in a concentration-dependent manner. In addition, Ikarisoside A reduced the release of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta). Furthermore, Ikarisoside A inhibited the activity of p38 kinase and nuclear factor-kappaB (NF-kappaB), which are signaling molecules involved in NO production. NO production was inhibited when the cells were treated with LPS and either SB 203580 (a p38 inhibitor) or Bay 11-7082 (an inhibitory kappaB kinase 2 inhibitor). These results suggest that Ikarisoside A inhibits the production of NO by inhibiting the activity of p38 MAPK and NF-kappaB. As a result of these properties, Ikarisoside A has the potential to be used as an effective anti-inflammatory agent.

Hypoxia-inducible factor-1 (HIF-1) is an important tumor-selective therapeutic target for solid tumors. Icariside II was isolated from Epimedium koreanum through successive fractionation with ethyl acetate, n-butanol, chloroform and hexane, followed by gel column chromatography. Icariside II attenuated the protein level of HIF-1alpha induced by hypoxia in human osteosarcoma (HOS) cells in a concentration-dependent manner, probably by enhancing the interaction rate between von Hippel-Lindau (VHL) and HIF-1alpha. Furthermore, Icariside II down-regulated the levels of HIF-inducible genes involved in angiogenesis, metastasis, and glucose metabolism, such as vascular endothelial growth factor (VEGF), urokinase plasminogen activator receptor (uPAR), adrenomedullin (ADM), matrix metalloproteinase 2 (MMP2), aldolase A, and enolase 1 in HOS cells. Icariside II also inhibited the migration rate in HOS cells and tube formation rate in human umbilical vein endothelium cells (HUVECs). Overall, these results suggest the potential use of Icariside II as a therapeutic candidate against various diseases that involve overexpression of HIF-1alpha.

With the goal of developing Alzheimer's disease therapeutics, we have designed and synthesized new piperidine derivatives having dual action of acetylcholinesterase (AChE) and beta-amyloid peptide (Abeta) aggregation inhibition. For binding with the catalytic site of AChE, an ester with aromatic group was designed, and for the peripheral site, another aromatic group was considered. And for intercalating amyloid-beta oligomerization, long and linear conformation with a lipophilic group was considered. The synthetic methods employed for the structure with dual action depended on alcohols with an aromatic ring and the substituted benzoic acids, which are esterificated in the last step of the synthetic pathway. We screened these new derivatives through inhibition tests of acetylcholinesterase, butyrylcholinesterase (BChE), and Abeta(1-42) peptide aggregation, AChE-induced Abeta(1-42) aggregation. Our results displayed that compound 12 showed the best inhibitory potency and selectivity of AChE, and 29 showed the highest selectivity of BChE inhibition. Compounds 15 and 12 had inhibitory activities against Abeta(1-42) aggregation and AChE-induced Abeta aggregation. In the docking model, we confirmed that 4-chlorobenzene of 12 plays the parallel pi-pi stacking against the indole ring of Trp84 in the bottom gorge of AChE. Because the benzyhydryl moiety of 12 covered the peripheral site of AChE in a funnel-like shape, 12 showed good inhibitory potency against AChE and could inhibit AChE-induced Abeta(1-42) peptide aggregation.

The immediate-type allergic reaction (anaphylaxis) is involved in many allergic diseases such as asthma, allergic rhinitis and sinusitis. We investigated the effect of the gall of Rhus javanica (GRJ) on the model of the immediate-type allergic reaction, and studied its possible mechanisms. GRJ inhibited compound 48/80-induced systemic reactions in mice. GRJ attenuated immunoglobulin (Ig) E-mediated local allergic reactions. In addition, GRJ dose dependently decreased histamine release from rat peritoneal mast cells activated by compound 48/80 or IgE. The decreasing effect of GRJ on the histamine release was mediated by the modulation of cAMP and [Ca 2+ ]i in mast cells. Furthermore, GRJ decreased the phorbol 12-myristate 13-acetate plus calcium ionophore A23187-stimulated TNF-α and IL-6 secretion in human mast cells. The inhibitory effect of GRJ on the pro-inflammatory cytokine was c- Jun N-terminal kinase and nuclear factor-κB dependent. Our findings provide evidence that GRJ inhibits mast cell-derived immediate-type allergic reactions, and suggest the possible mechanisms of action.

The present study was carried out to determine the feasibility of using gel formulations for the transdermal delivery of triamcinolone acetonide (TA), which is one of the synthetic glucocorticoids, in conjunction with phonophoresis, and to develop the carbopol gels of TA. For this purpose, the anti-inflammatory effects of the gel containing TA after the adoption of ultrasound were evaluated by investigating the in vivo change in the serum creatine phosphokinase (CPK) and histological findings. Following a muscle injury, the serum CPK activity decreased significantly in the TA gel group with phonophoresis, comparing with that in the control group and the commercial gel group given ultrasound. In the gross finding, after a muscle injury, the TA gel group with phonophoresis showed rapid moderation of the injury compared with the three other groups. The histological findings showed that the inflammation was relieved within 72 h after the injury from the TA gel group with phonophoresis. These effects were considerably higher in the phonophoresis group than in the other three groups. Overall, a TA gel using phonophoresis might be used as a new transdermal delivery technique providing enhanced anti-inflammatory effects.

Dioscoreae Rhizoma (MDR), the root of Dioscorea tokoro MAKINO, has been used for the treatment of arthritis, muscular pain and urinary diseases in oriental medicine. The present work evaluates a methanol extract of Dioscoreae Rhizoma (MDR). MDR did not show any cytotoxic effect on mouse lung fibroblast cells (mLFCs) or human fibroblast-like synovial cells (hFLSCs). However, it significantly reduced the proliferation of hFLSCs stimulated by interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha). MDR significantly inhibited the production of TNF-alpha and IL-1beta as well as down-regulating the expression of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) in IL-1beta- and TNF-alpha-stimulated hFLSCs. MDR also effectively reduced the level of reactive oxygen species (ROS) in these cells. Taken together, these findings provide evidence that MDR may be a candidate for the treatment of rheumatoid arthritis (RA).

After the introduction of the da Vinci system (Intuitive Surgical, Sunnyvale, CA, USA), the trend in minimally invasive surgery accelerated, including robot-assisted partial nephrectomy (RPN) for treatment of localized renal tumors [1]. Introduction of the robotic platform showed great advantages in terms of learning curve and feasibility in the field of minimally invasive surgery [2]. However, the robotic platform had some specific limitations such as the absence of tactile feedback, and the costs and maintenance of the equipment remain high [3]. Recently, the markets for robotic platforms have been varied, and new robotic platforms have been developed. In Korea, a new robotic platform has been developed, called REVO-I (model MSR5000; Meerecompany Inc, Seongnam, Republic of Korea), and we performed a pilot study of the benefits of this platform in porcine models with RPN. The REVO-I robot consists of a surgeon control console (MSRC-5000), a four-arm robotic operation cart (MSRO5000), a high-definition (HD) vision cart (MSRV-5000), and reusable endoscopic instruments (Fig. 1). After induction of general anesthesia, the pig was placed in a lateral flank position. The first and second procedureswere performed in lower pole kidney, and the third and fourth procedureswere performed in upper pole kidney. The surgeon was placed at the surgeon control console, and the first assistant was positioned at the robotic operation cart. RPN was performed through one supraumbilical 12.2mm port and three 9.3-mm robotic ports. A 12.2-mm camera port was inserted just superior to the umbilicus, a 9.3-mm port was placed just lateral to the midline between the umbilicus and xiphoid, and two 9.3-mm ports were caudal and lateral from the supraumbilical port. A 12-mm assistant port was placed caudal to the supraumbilical port. We used four robotic arms: one for the three-dimensional-HD 10-mm scope (Conmed, Utica, NY, USA) and three for the operative instruments. An additional lateral 12-mm port was placed for the assistant instruments. Instruments including a Maryland bipolar grasper, monopolar scissors

The whole plants of Carpesium triste var. manshuricum afforded two known and two new germacranolides, 2α,5-epoxy-5,10-dihydroxy-6α-angeloyloxy-9β-(2-methylbutyloxy)-germacran-8α, 12-olide and 2α,5-epoxy-5,10-dihydroxy-6α-angeloyloxy-9β-(3-methylbutyloxy)-germacran-8α, 12-olide. Their structures were established by physicochemical and spectroscopic methods.

The aerial parts of Carpesium divaricatum afforded two known and two new germacranolides, 2β,5-epoxy-5,10-dihydroxy-6α-angeloyloxy-9β-isobutyloxy-germacran-8α,12-olide and 2α,5-epoxy-5,10-dihydroxy-6α-angeloyloxy-9β-isobutyloxy-germacran-8α,12-olide.